1. Housing and Health –
The Connections
(and why the Government is looking in the wrong place
for a solution to the housing crisis)
Peter Ambrose
Visiting Professor in Housing Studies
Health and Social Policy Research Centre
University of Brighton, England
Socialist Health Association
Camden
23 February 2008

2. Establishing housing/health links
• It is not easy – the medical profession often uses a
different standard of proof
• Health status is an outcome of a large set of factors
• Best to argue that good housing is a necessary but not
sufficient condition for good health
• Well-designed chronological ‘intervention’ studies give
best chance to demonstrate the relationship
• But these are difficult to carry out

3. The Stepney ‘Health Gain’ Study
1995-2001
• Contracted to assess the health gain from the SRB1
renewal of two estates
• Sample of households surveyed for self-reported health
before and after the area improvement
• Self-reported ‘illness days’ fell from 35% of all person/days
to 7%
• These findings, and the connection to housing quality,
backed up by professional opinion in the area
• Project judged as one of 19 acceptable ‘intervention’
studies from 30,000 assessed (MRC Project at Glasgow
University)

4. Other recent empirical work
• Stepney study found that better housing was linked to
huge health improvement – but increased housing costs
causing stress and problems
• So ‘healthy housing’ means affordable housing!
• Work on households with low incomes in Brighton and
Hove showed the extent of stress caused by high housing
costs – as did study of debt levels in Brighton and
Hastings
• Current study of SE region for UNISON showing 76% of
households say high living/housing costs affecting health -
and these are households in top third of income range!

5. So what is happening here?
• 1993 to 2004: gross earnings index +59.1%
house price index +306.8%
• Recent survey - nurses cannot afford to buy in 97% of
towns surveyed (was 43% in 2001)
• Nationwide ratio of house prices to gross annual earnings
historically 2.5 to 4.0 – was over 6.0 in London for 14
quarters to late 2006

6. Deep orange areas – house prices =
more than 8x earnings

7. How over-lending has produced
the problem
In the 1980s the Thatcher Governments deregulated the
finance sector = huge flow of house purchase credit
– House Purchase Debt outstanding 1980 = £53bn
– if updated to 2007 at general inflation = £154bn
– if allow for expansion of OO volume = £192bn
– actual 2007 House Purchase Debt = £1000bn+
= £800+ bn ‘excess’ House Purchase Debt
- Has risen from 23% to 80% of GDP

8. House prices, consumer prices and
earnings since 1980

9. NB - The effects of prices on
rent levels
• Two connecting mechanisms between price levels and rent
levels:
- since 2000 new ‘social’ rent-setting formula
has taken capital values into account
- in private rented sector the proprietors look
for a competitive level of net return on
capital values of properties
• Result - from 1980 to 2003 average % of male earnings
taken by rents has risen:
Public sector + 93%
Not for profit sector + 37%
Private sector +122%

10. Heavy long-term mortgage
debt means…
– long term exposure to interest rate risks
– constraints on making private pension provision
– effect on work/life balance? (NB UK long working hours
and EU Working Time Directive issue)
– effects on age of bearing first child? (future NHS costs)
– more reliance on non-parental childcare (both parents
working – connection to UNICEF Report findings?)
– more stressful complications on relationship break-up
– effects on organised labour’s bargaining capacity
– mortgage repayments maybe continuing into
retirement?
all these can have adverse effects on health
and welfare and generate public costs

11. …and the Government’s response?
• Simply increase supply by a target amount that most agree
is not enough
• Use the words ‘affordable’ and ‘social housing’ without
realistic definition in terms of household finances – we
need precise definitions!
• And what if output goes up by 1% per year but the flow of
lending increases by 5% per year (as it is at present)?
• A HOLISTIC policy required that takes steps to regulate
lending as well as increasing supply
• And we need to measure the health and other costs of NOT
adopting rational long-term housing policies

12. Thanks for listening